Metastatic Marjolin Ulcers: A Systematic Review and Single-center Experience.

Area of Science:

• Oncology
• Dermatology
• Cutaneous Malignancies

Background:

• Marjolin ulcers (MUs) are rare, aggressive skin cancers arising from chronic wounds or inflammation.
• MUs exhibit higher rates of nodal metastases and recurrence, leading to a poorer prognosis than other skin malignancies.
• Management and outcomes for metastatic MUs are not well-established, despite surgery being the primary treatment.

Purpose of the Study:

• To review existing literature on treatment strategies for metastatic Marjolin ulcers.
• To report institutional experience with metastatic MUs to highlight challenges in management.
• To stimulate interest in this difficult-to-treat cutaneous malignancy.

Main Methods:

• A systematic review of English-language literature on metastatic MUs was conducted.
• The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
• An institutional case series from a rural African hospital was included.

Main Results:

• Nine studies comprising 129 patients were included, with a mean age of 50.3 years.
• Squamous cell carcinoma was the predominant type (97%), often arising from burn scars (54%).
• Metastases commonly affected lymph nodes, lungs, and liver; survival data were limited.

Conclusions:

• No consistently effective treatments for metastatic MUs were identified in the review.
• Current management is largely palliative and resource-dependent, indicating a need for standardized approaches.
• Optimizing patient outcomes requires a more standardized treatment strategy for metastatic MUs.